Gavin Tansley1,2, Barclay T Stewart3,4,5, Adam Gyedu6, Godfred Boakye4, Daniel Lewis7, Marius Hoogerboord8, Charles Mock3,9,10. 1. Department of Surgery, Dalhousie University, Room 8-821, 1276 South Park St, Halifax, NS, B3H2Y9, Canada. gtansley@dal.ca. 2. Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. gtansley@dal.ca. 3. Department of Surgery, University of Washington, Seattle, WA, USA. 4. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 5. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. 6. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 7. Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. 8. Department of Surgery, Dalhousie University, Room 8-821, 1276 South Park St, Halifax, NS, B3H2Y9, Canada. 9. Harborview Injury Prevention & Research Centre, Seattle, WA, USA. 10. Department of Global Health, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need. METHODS: Using geospatial methods, this study explores the district-level variation of two access barriers in Ghana: poverty and spatial access to care. National survey data were used to estimate the average total household expenditure (THE) in each district. Estimates of the spatial access to essential surgical care were generated from a cost-distance model based on a recent surgical capacity assessment. Correlations were analyzed using regression and displayed cartographically. RESULTS: Both THE and spatial access to surgical care were found to have statistically significant regional variation in Ghana (p < 0.001). An inverse relationship was identified between THE and spatial access to essential surgical care (β -5.15 USD, p < 0.001). Poverty and poor spatial access to surgical care were found to co-localize in the northwest of the country. CONCLUSIONS: Multiple barriers to accessing surgical care can coexist within populations. A careful understanding of all access barriers is necessary to identify and target strategies to address unmet surgical need within a given population.
BACKGROUND: Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need. METHODS: Using geospatial methods, this study explores the district-level variation of two access barriers in Ghana: poverty and spatial access to care. National survey data were used to estimate the average total household expenditure (THE) in each district. Estimates of the spatial access to essential surgical care were generated from a cost-distance model based on a recent surgical capacity assessment. Correlations were analyzed using regression and displayed cartographically. RESULTS: Both THE and spatial access to surgical care were found to have statistically significant regional variation in Ghana (p < 0.001). An inverse relationship was identified between THE and spatial access to essential surgical care (β -5.15 USD, p < 0.001). Poverty and poor spatial access to surgical care were found to co-localize in the northwest of the country. CONCLUSIONS: Multiple barriers to accessing surgical care can coexist within populations. A careful understanding of all access barriers is necessary to identify and target strategies to address unmet surgical need within a given population.
Authors: Reinou S Groen; Mohamed Samai; Kerry-Ann Stewart; Laura D Cassidy; Thaim B Kamara; Sahr E Yambasu; T Peter Kingham; Adam L Kushner Journal: Lancet Date: 2012-08-14 Impact factor: 79.321
Authors: Barclay T Stewart; Robert Quansah; Adam Gyedu; James Ankomah; Peter Donkor; Charles Mock Journal: World J Surg Date: 2015-10 Impact factor: 3.352
Authors: Gavin Tansley; Barclay Stewart; Ahmed Zakariah; Edmund Boateng; Christiana Achena; Daniel Lewis; Charles Mock Journal: Prehosp Emerg Care Date: 2016-04-13 Impact factor: 3.077
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Robin C Nesbitt; Sabine Gabrysch; Alexandra Laub; Seyi Soremekun; Alexander Manu; Betty R Kirkwood; Seeba Amenga-Etego; Kenneth Wiru; Bernhard Höfle; Chris Grundy Journal: Int J Health Geogr Date: 2014-06-26 Impact factor: 3.918
Authors: Adam Gyedu; Barclay Stewart; Cameron Gaskill; Godfred Boakye; Ebenezer Appiah-Denkyira; Peter Donkor; Ronald Maier; Robert Quansah; Charles Mock Journal: Ann Surg Date: 2018-08 Impact factor: 12.969
Authors: Barclay T Stewart; Adam Gyedu; Cameron Gaskill; Godfred Boakye; Robert Quansah; Peter Donkor; Jimmy Volmink; Charles Mock Journal: World J Surg Date: 2018-10 Impact factor: 3.352
Authors: Gary R Watmough; Magnus Hagdorn; Jodie Brumhead; Sohan Seth; Enrique Delamónica; Charlotte Haddon; William C Smith Journal: Sci Data Date: 2022-05-17 Impact factor: 8.501
Authors: Barclay T Stewart; Adam Gyedu; Stephanie K Goodman; Godfred Boakye; John W Scott; Peter Donkor; Charles Mock Journal: Afr J Emerg Med Date: 2020-11-16
Authors: Winfred Dotse-Gborgbortsi; Nicola Wardrop; Ademola Adewole; Mair L H Thomas; Jim Wright Journal: Int J Health Geogr Date: 2018-05-23 Impact factor: 3.918
Authors: Stephen Tabiri; Katie W Russell; Frank E Gyamfi; Ali Jalali; Raymond R Price; Micah G Katz Journal: PLoS One Date: 2018-11-21 Impact factor: 3.240
Authors: Kerry Lm Wong; Oliver J Brady; Oona Maeve Renee Campbell; Christopher I Jarvis; Andrea Pembe; Gabriela B Gomez; Lenka Benova Journal: BMJ Glob Health Date: 2019-08-21